Understanding anatomy of the petrous pyramid - a new compartmental approach.

Understanding anatomy of the petrous pyramid - a new compartmental approach.

World Neurosurg. 2019 Jan 05;:

Authors: Tawfik-Helika M, Mertens P, Ribas G, Catala M, Kirollos R, Jacquesson T

Abstract
BACKGROUND: Surgical anatomy of the petrous pyramid has always been a challenge, especially in the beginning of the training process. Providing an easier, holistic approach can be of help to everyone with interest in learning and teaching skull base anatomy. We present the complex organization of the petrous pyramid anatomy using a new compartmental approach that is simple to understand and remember.
METHODS: The contents of the petrous pyramid of eight temporal bones were exposed through progressive drilling of the superior surface.
RESULTS: The petrous pyramid is made of a bony container, while its contents were grouped into four compartments (mucosal, cutaneous, neural and vascular). Two reference lines were identified (mucosal and external-internal auditory canal lines) intersecting at the level of the middle ear. The localization of contents relative to these reference lines was then described and two methods of segmentation; the X-method and V-method, were then proposed. This description was then used to describe middle ear relationships, facial nerve anatomy and air cell distribution.
CONCLUSION: This new simple compartmental approach allows a comprehensive understanding of the distribution of petrous pyramid contents. Dividing it into anatomical compartments ,and then navigating this mental map along specific reference points, lines, spaces, and segments could bring a useful tool to teach or learn its complex tridimensional anatomy.

PMID: 30620892 [PubMed - as supplied by publisher]

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